In The News - 5/6/2024
The Wall St. Journal
(Paywall - contact dsimonson@mac.com for full text)
A Lawyer’s Slide Into Psychosis Was Captured in a WSJ Profile. He Tells Us His Story.
Rob Dart has spent a year on the streets believing people are trying to control him via hypnosis
This Rob, who arrives on time for our interview, is standing by the roadside under the blazing California sun, his eyes and hair competing in wildness, his grin difficult not to match.
In the past year, this Rob has been hospitalized, shot, housed, unhoused, a winner and a loser in court battles. Ultimately, he has shed every scrap of evidence of his life before illness: his connections to his son, family and most friends. He wanders the streets of greater Los Angeles, begging for change and lying down to sleep when he is tired. He believes people are controlling him via hypnosis, activated by a headlock.
Rob, 44, doesn’t believe he is sick. He has refused treatment repeatedly. During a hospitalization last year, he argued remotely before a judge from his hospital bed that he shouldn’t be committed. The judge agreed.
“I did want to leave the hospital, and I did not want to take the medications,” Rob said.
Rob’s situation isn’t that uncommon. Doctors said his behavior is consistent with anosognosia, a neurological condition in patients unaware of their neurological deficit or psychiatric state. More than half of patients with schizophrenia and 40% of patients with bipolar disorder demonstrate anosognosia or severe lack of insight, studies show.
They present a conundrum for society: how to balance individual rights with people’s basic health? Solving the nation’s mental-health crisis requires the participation of some people who don’t think they need help.
Hundreds of people responded to a Wall Street Journal profile of Rob with stories of their own fights to help people lost in their own delusions. Some of their loved ones found stability after years of chaos. But many family members said they have spent decades living in the grief of losing someone in plain sight.
“Is it a biochemical disorder? Is it neurodiversity? Is it eccentricity? And who gets to decide?” said Elyn Saks, a professor of law, psychology, psychiatry and behavioral sciences at the University of Southern California, who has schizophrenia.
Each person experiences delusions in their own way, Saks said, and medication doesn’t always erase them. Some people have delusions that last years. Others only experience delusions under severe stress. “Psychosis is not like an on/off switch, but a dimmer,” Saks said.
Rob draws no distinction between his current and former life. While friends and family say mental illness has taken everything from him, Rob says going off his medications has added context and texture to his experience of life.
“You realize you’re kind of the same person,” he said. “You just know more about yourself.”
Many states are trying to figure out how to help people like Rob. Nearly every state has laws allowing for court-ordered outpatient treatment.
Some states are building hospitals, or moving people from encampments to shelters. California is creating courts for mental health to move people who need help off the streets and into treatment. California and Washington are among states that have expanded laws allowing civil commitment for reasons other than violence